Neuroparacoccidioidomicosis: para tener presente / Neuroparacoccidiodomycosis to keep in mind:

La paracoccidioidomicosis (PCM) es una micosis endémica de zonas tropicales y subtropicales, con mayor prevalencia en América Latina, producida por especies del género Para-coccidioides. Es una micosis profunda sistémica que en su forma crónica afecta principalmente a varones adultos. La afectación del sistema nervioso central (SNC) está descrita en un 10-27%. Nosotros presentamos dos casos con mani-festación neurológica al ingreso

Paracoccidioidomycosis (PCM) is an endemic mycosis, from tropical and subtropical zones, with a higher prevalence in Latin America, produced by species of the genus Paracoccidioides. It is a deep chronic systemic my-cosis, which mainly affects adult males. The involvement of the central nervous system (CNS) is described in 10-27%. We present two cases with neurological manifestation upon admission.

Retrospective evaluation of the clinical characteristics associated with Corynebacterium species bacteremia

ABSTRACT Objectives: Corynebacterium spp. are becoming recognized as pathogens that potentially cause various infections. We aimed to evaluate the clinical characteristics associated with Corynebacterium spp. bacteremia. Patients and methods: We retrospectively reviewed the medical records of all adult patients who had positive blood cultures for Corynebacterium spp. in a single university hospital between January 2014 and December 2016. Patients were divided into a bacteremia group and a contamination group based on microbiological test results and clinical characteristics. Patients' characteristics, antimicrobial susceptibility of isolated species, antimicrobials administered, and patient outcomes were evaluated. Results: Corynebacterium spp. were isolated from blood samples of 63 patients; Corynebacterium striatum was the predominant isolate. Twenty-eight patients were determined to have bacteremia. Younger age (p = 0.023), shorter time to positivity (p = 0.006), longer hospital stay (p = 0.009), and presence of an indwelling vascular catheter (p = 0.002) were observed more often in the bacteremia group compared to the contamination group. The source of infection in most patients with bacteremia was an intravenous catheter. All tested strains were susceptible to vancomycin. Four of the 27 patients with bacteremia died, despite administration of appropriate antimicrobial therapy. Conclusions: We found that younger age, shorter time to positivity, and presence of an indwelling catheter were related to bacteremia caused by Corynebacterium spp. Appropriate antimicrobials should be administered once Corynebacterium spp. are isolated from the blood and bacteremia is suspected.

Combined parasitological and molecular-based diagnostic tools improve the detection of Trypanosoma cruzi in single peripheral blood samples from patients with Chagas disease

Abstract INTRODUCTION In order to detect Trypanosoma cruzi and determine the genetic profiles of the parasite during the chronic phase of Chagas disease (ChD), parasitological and molecular diagnostic methods were used to assess the blood of 91 patients without specific prior treatment. METHODS Blood samples were collected from 68 patients with cardiac ChD and 23 patients with an indeterminate form of ChD, followed by evaluation using blood culture and polymerase chain reaction. T . cruzi isolates were genotyped using three different genetic markers. RESULTS: Blood culture was positive in 54.9% of all patients, among which 60.3% had the cardiac form of ChD, and 39.1% the indeterminate form of ChD. There were no significant differences in blood culture positivity among patients with cardiac and indeterminate forms. Additionally, patient age and clinical forms did not influence blood culture results. Polymerase chain reaction (PCR) was positive in 98.9% of patients, although comparisons between blood culture and PCR results showed that the two techniques did not agree. Forty-two T . cruzi stocks were isolated, and TcII was detected in 95.2% of isolates. Additionally, one isolate corresponded to TcIII or TcIV, and another corresponded to TcV or TcVI. CONCLUSIONS Blood culture and PCR were both effective for identifying T. cruzi using a single blood sample, and their association did not improve parasite detection. However, we were not able to establish an association between the clinical form of ChD and the genetic profile of the parasite.

Desarrollo y validación de un modelo predictor para bacteriemia en pacientes hospitalizados por el servicio de urgencias con sospecha de infección / Development and validation of a predictive model for bacteremia in patients hospitalized by the emergency department with suspected infection

Background: Positive blood cultures usually indicate disseminated infection that is associated with a poor prognosis and higher mortality. We seek to develop and validate a predictive model to identify factors associated with positive blood cultures in emergency patients. Methods: Secondary analysis of data from two prospective cohorts (EPISEPSIS: developing cohort, and DISEPSIS: validation cohort) of patients with suspected or confirmed infection, assembled in emergency services in 10 hospitals in four cities in Colombia between September 2007 and February 2008. A logistic multivariable model was fitted to identify clinical and laboratory variables predictive of positive blood culture. Results: We analyzed 719 patients in developing and 467 in validation cohort with 32% and 21% positive blood cultures, respectively. The final predictive model included variables with significant coefficients for both cohorts: temperature > 38° C, Glasgow < 15 and platelet < 150.000 cells/mm³, with calibration (goodness-of-fit H-L) p = 0.0907 and p = 0.7003 and discrimination AUC = 0.68 (95% CI = 0.65-0.72) and 0.65 (95% CI = 0.61-0.70) in EPISEPSIS and DISEPSIS, respectively. Specifically, temperature > 38 °C and platelets < 150.000 cells/mm³ and normal Glasgow; or Glasgow < 15 with normal temperature and platelets exhibit a LR between 1,9 (CI 95% = 1,2-3,1) and 2,3 (CI 95% = 1,7-3,1). Glasgow < 15 with any of low platelets or high temperature shows a LR between 2,2 (CI 95% = 1,1-4,4) and 2,6 (CI 95% = 1,7-4,3). Discussion: Temperature > 38° C, platelet count < 150,000 cells/mm³ and GCS < 15 are variables associated with increased likelihood of having a positive blood culture.

Introducción: Un hemocultivo positivo usualmente indica infección diseminada, la que se asocia con peor pronóstico y mayor mortalidad. Por tanto, buscamos desarrollar y validar un modelo de predicción que permita identificar los factores asociados con la positividad de los hemocultivos en pacientes del servicio de urgencias. Métodos: Análisis secundario de datos de dos cohortes prospectivas (EPISEPSIS: cohorte de desarrollo y DISEPSIS: cohorte de validación) de pacientes con sospecha o confirmación de infección, ensambladas en servicios de urgencias de 10 instituciones hospitalarias en cuatro ciudades de Colombia entre septiembre de 2007 y febrero de 2008. Se ajustó un modelo logístico multivariado para identificar variables clínicas y de laboratorio predictoras de hemocultivos positivos. Resultados: Se analizaron 719 pacientes en la cohorte de desarrollo y 467 en la cohorte de validación, con 32 y 21% de hemocultivos positivos, respectivamente. El modelo predictor final incluyó las variables con coeficientes significativos para ambas cohortes: temperatura ≥ 38 °C, Glasgow < 15 y plaquetas ≤ 150.000 céls/mm³ con calibración (bondad de ajuste de H-L) p = 0,0907 y p = 0,7003 y discriminación AUC: 0,68 (IC 95%: 0,65-0,72) y 0,65 (IC 95%: 0,61-0,70) en EPISEPSIS y DISEPSIS, respectivamente. Temperatura ≥ 38 °C y recuento de plaquetas ≤ 150.000 céls/mm³ con Glasgow normal; o Glasgow < 15 con temperatura y plaquetas normales tiene un LR entre 1,9 (IC 95%: 1,2-3,1) y 2,3 (IC 95%: 1,7-3,1). La escala de Glasgow < 15 puntos junto con cualquiera entre recuento de plaquetas o temperatura alteradas tiene un LR entre 2,2 (IC 95%: 1,1-4,4) y 2,6 (IC 95%: 1,7-4,3). Discusión: La temperatura ≥ 38 °C, el recuento de plaquetas ≤ 150.000 céls/mm³ y la escala de Glasgow < 15 son las variables asociadas con mayor probabilidad de tener un hemocultivo positivo.